Department of Psychiatry, Yale University, New Haven, Connecticut.
VA Connecticut Healthcare System, West Haven, Connecticut.
Pain Med. 2019 Mar 1;20(3):528-542. doi: 10.1093/pm/pny071.
High proportions of post-9/11 veterans have musculoskeletal disorders (MSDs), but engaging them in care early in their course of illness has been challenging. The service connection application is an ideal point of contact for referring veterans to early interventions for their conditions.
Among MSD claimants who reported risky substance use, we pilot-tested a counseling intervention targeting pain and risky substance use called Screening Brief Intervention and Referral to Treatment-Pain Module (SBIRT-PM). Veterans were randomly assigned in a 2:1:1 ratio to SBIRT-PM, Pain Module counseling only, or treatment as usual (TAU).
Participants assigned to either counseling arm were offered a single meeting with a study therapist with two follow-up telephone calls as needed. Participants completed outcome assessments at four and 12 weeks after randomization.
Of 257 veterans evaluated, 101 reported risky substance use and were randomized. Counseling was attended by 75% of veterans offered it and was well received. VA pain-related services were used by 51% of participants in either of the pain-focused conditions but only by 27% in TAU (P < 0.04). Starting with average pain severity ratings of 5.1/10 at baseline, only minimal changes in mean pain severity were noted regardless of condition. Self-reported risky substance use was significantly lower over time in the SBIRT-PM condition relative to the two other conditions (P < 0.02). At week 12, proportions of veterans reporting risky substance use were 0.39, 0.69, and 0.71 for the SBIRT-PM, Pain Module counseling, and TAU conditions, respectively.
SBIRT-PM shows promise as a way to engage veterans in pain treatment and reduce substance use.
许多 9·11 后退伍军人患有肌肉骨骼疾病（MSD），但在他们疾病早期让他们接受治疗一直具有挑战性。服务连接申请是将退伍军人转介到他们疾病早期干预的理想切入点。
在报告有危险物质使用风险的 MSD 索赔者中，我们对一种针对疼痛和危险物质使用的咨询干预措施进行了试点测试，称为筛选性简短干预和转介治疗-疼痛模块（SBIRT-PM）。退伍军人以 2:1:1 的比例随机分配到 SBIRT-PM、仅疼痛模块咨询或常规治疗（TAU）。
分配到任何咨询组的参与者都将接受一位研究治疗师的单次会议，并根据需要进行两次后续电话咨询。参与者在随机分组后 4 周和 12 周完成了结果评估。
在评估的 257 名退伍军人中，有 101 名报告有危险物质使用风险并被随机分组。有 75%的退伍军人参加了咨询，并且反响良好。在任何一种以疼痛为重点的情况下，51%的参与者都使用了 VA 疼痛相关服务，但在 TAU 中只有 27%（P<0.04）。从基线时平均疼痛严重程度评分为 5.1/10 开始，无论条件如何，平均疼痛严重程度的变化都很小。无论条件如何，SBIRT-PM 组的自我报告危险物质使用在一段时间内都显著低于其他两组（P<0.02）。在第 12 周，SBIRT-PM、疼痛模块咨询和 TAU 条件下报告危险物质使用的退伍军人比例分别为 0.39、0.69 和 0.71。
SBIRT-PM 有望成为一种让退伍军人参与疼痛治疗和减少物质使用的方法。
